FREQUENTLY ASKED QUESTIONS

Transcription

1 FREQUENTLY ASKED QUESTIONS Annual Enrollment GENERAL What s changing for 2017? How did Progressive determine the rates for our medical plans in 2017? Who can I cover on my benefits? Can I make a change to my benefits mid-year? If I m happy with my benefits as they are, do I need to complete this year's Annual Enrollment? What does it mean that Progressive is self-insured? What is the Vitality program? What is Teladoc? What is the Resources for Living program? What is the Hyatt Legal Plan benefit? What s included in the Identity Theft Protection? How do Aflac offerings work? Do I need to elect life insurance for myself in order to elect life insurance for my spouse and/or child(ren)? Are there any plans in place to further evaluate and/or change the current health benefit plans offered? MEDICAL What are deductibles, coinsurance, and out-of-pocket maximums? I read that in-network preventive care is covered 100%, but what qualifies as preventive? What s the difference in prescription coverage between our two plans? How does coordination of benefits work with a spouse s insurance? One of my doctors asked me for payment while I was at the office. Should I be paying my doctor before I receive my Explanation of Benefits from Aetna? DENTAL What are my dental plan options? Why isn t my dentist in the network? Do I need to get pre-certification for dental work? FLEXIBLE SPENDING ACCOUNT (FSA) / HEALTH SAVINGS ACCOUNT (HSA) How much will I really save using an FSA? What s the difference between the Health Care FSA and the Child/Adult Care FSA? Can I have an FSA and HSA? When is the money I put into an FSA or HSA available for reimbursement? If I contribute money to an FSA and don t use it by the end of the year, do I lose it? What if I don t use all of my HSA funds by the end of the year? I m planning to use my FSA for orthodontia expenses. Is there anything I need to know? I currently have a health care FSA and am considering enrolling in the High Deductible Plan and opening an HSA. Is there anything I should know? Are FSA debit cards available? Can I increase my FSA or HSA contribution amount at any time?

2 GENERAL What s changing for 2017? The in-network deductibles in the Standard Deductible plan will increase from $500 per individual and $1,000 per family, to $600 per individual and $1,200 per family. The out-of-network deductibles in this plan will increase from $1,000 per individual and $2,000 per family, to $1,200 per individual and $2,400 per family. For Health Savings Accounts, the IRS maximum contribution for individual coverage will increase slightly from $3,350 to $3,400. How did Progressive determine the rates for our medical plans in 2017? In 2017, employee rates for the Progressive medical plans will increase by $2 - $22 per pay period, depending on the plan you choose, who s covered by your plan, and whether the working spouse fee or tobacco-free discount applies. Our dental and vision plan premiums will also change, with dental rate increases ranging from $ $0.70 per pay period and vision rate changes ranging from a $0.05 decrease to a $0.10 increase per pay period. Rates for our spouse life insurance and child life insurance will decrease, while rates for our optional life insurance, long-term disability, identity theft benefit, Hyatt Legal plan, and Aflac will all remain the same. Though our health plan rates are based on our previous 12 months of claims experience, there are many other components that go into projecting the claims costs and determining the rates for the new plan year: Trend Most years, the majority of the rate change can be attributed to trend, which accounts for anticipated changes to medical and pharmacy costs in the market, as well as changes in how our employees use the medical benefits. In 2017, we anticipate that medical trend will be 6.5% and pharmacy trend will be 11.7%. Cost Share When we look at the combination of bi-weekly premium contributions and out-of-pocket expenses, our goal is for Progressive to pay about 2/3 of the total cost, while employees pay about 1/3. The actual employee cost share continues to fall well short of our target, so we are implementing two changes that will help us move closer to the target. First, the employee share of bi-weekly premiums will increase in 2017, with the majority of this increase occurring in plans that cover spouses and/or children. The second piece addresses employee out-of-pocket expenses. In 2017, the deductible on the Standard Deductible plan will increase to $600 for an individual and $1,200 for a family for in-network services, and $1,200 for an individual and $2,400 for a family for out-of-network services. Both of these changes will help us move toward our cost share target and better align our plans with comparable healthcare plans in the market. The premium share changes also help address the rising costs of our covered spouses. Expenses for spouses on our plan average nearly 40% more than expenses for employees. Plan Changes Rate adjustments are also made to account for changes in plan design and coverage. Downward rate adjustments were made to the 2017 rates due to both pharmacy discount improvements and the deductible increase mentioned above. There are no significant plan changes for dental or vision coverage in Tier Differences We price our plans and tiers individually, based on the claims experience. As a result, employee rate changes will vary from tier to tier. Discounts Changes in discounts and surcharges directly impact the employee rates. However, there are no discount or surcharge changes in Employees who qualify for the tobacco-free discount will continue to pay $15 less per pay period, or $390 less per year, than those who do not qualify. Employees who cover a spouse who is employed and has access to employer-subsidized medical coverage will continue to pay $45 more per pay period, or $1,170 more per year. In summary, the main factors driving our 2017 employee premiums are increases in medical and pharmacy trend and the adjustments made to address rising spouse costs and move closer to our employee cost share target.

3 Who can I cover on my benefits? You can cover yourself, your spouse, and your children (less than 26 years old). If you and your spouse are both Progressive people, you can elect one plan to cover both of you or choose to have separate employee coverage. In other words, you and your spouse can t have duplicate Progressive coverage. Can I make a change to my benefits mid-year? Other than Annual Enrollment, you can only make changes to your benefits within 60 days of a life event (e.g., marriage, birth, adoption). If I m happy with my benefits as they are, do I need to complete this year's Annual Enrollment? You must review your Annual Enrollment election options each year. There are a number of plan features that require active participation or they will default to elections that you may not want: You ll be asked if you are a tobacco user. If a selection isn t made, you will not receive the non-tobacco use discount and you ll be defaulted to the tobacco user life insurance premiums. You ll be asked if your spouse has access to employer-subsidized medical insurance. If a selection isn t made and your spouse is included on your medical plan, you ll be charged the Working Spouse Fee. If you elected the Flexible Spending Account (FSA) this year, you ll be asked to enter your 2017 contribution amount. If an amount isn t entered, you will not have an FSA for The benefits planning tools on our Annual Enrollment site can help you choose the best benefit plans for you and your family. What does it mean that Progressive is self-insured? Self-insured (also known as self-funded) means we assume the financial risk for providing health care to our employees. We put money directly into a plan, which pays for the covered benefits when claims are incurred, rather than paying premiums to insurance companies. We pay a third party (such as Aetna) to administer the plan we designed. By being self-insured, Progressive is able to save money by avoiding the profit margin insurance companies build into their premiums, but it also raises our financial exposure if more claims than anticipated must be paid. What is the Vitality program? Vitality is an interactive and personalized wellness rewards program that makes it easy and rewarding to live your healthiest life. The more healthy activities you do, the higher your Vitality status and the greater the rewards that come with it. Visit HealthyU > Vitality to learn more. What is Teladoc? If you re a Progressive medical plan participant, you can receive consultations with a U.S. board-certified doctor through phone, video or mobile app anytime. With Teladoc, you can talk to a doctor about common medical problems, such as cold and flu symptoms, sinus problems, allergies and ear infections. If medically necessary, you can even get certain prescriptions sent to your pharmacy. Your virtual visit cost is only $8 if you ve met your deductible or $40 if you haven t. Simply set up your online account, update your medical history, and request your consultation. For more information about this service, visit teladoc.com/aetna or call What is the Resources for Living program? Resources for Living is a program of free services, including the Employee Assistance Program (EAP) and Worklife Services. The EAP offers confidential, telephonic support for a variety of topics. Worklife Services provides free services such as Autism support, legal and financial counseling, convenience services, and identity-theft consultation.

4 What is the Hyatt Legal Plan benefit? For $16.50 per month through payroll deduction, you can receive unlimited access to professional legal advice and services for the most common personal legal matters through the Hyatt Legal Plan. This benefit provides you, your spouse and dependents with fully covered legal services from attorneys experienced in estate planning, civil suits, adoption, creditor issues and much more. There are no deductibles, copays, claim forms or usage limits when using a network attorney. Attorney assistance includes covered legal services, telephonic and in-person consultations, document preparation, and legal representation with no additional attorney fees. Visit info.legalplans.com and enter access code GetLaw for more information on this benefit. To enroll, select this option when making your benefits elections in HRexpress. What s included in the Identity Theft Protection benefit? Progressive offers identity theft protection through Kroll Background America, which is designed to alert you of suspicious account activity and to help restore any resulting damage to your credit history. For $5.98 per pay period, the service provides you with a current credit report, detailed analysis of your credit score (first year only), continuous credit monitoring, and identity restoration. For more information, visit the Benefits site. How do Aflac offerings work? The Personal Accident Plan and the Cancer Insurance Plan offered by Aflac are insurance products that provide a direct cash benefit to you and your dependents to offset the loss of income you experience and to offset costs that traditional health plans don t cover when you re ill or injured. The Personal Sickness Plan provides a direct cash benefit to help alleviate the cost of services like doctor visits, hospitalization, diagnostic testing, and maternity situations. Progressive employees should work directly with Aflac with these additional insurance products. While accidents, cancer diagnosis/treatment, and sicknesses are covered by our plans, Aflac s programs could provide direct cash benefits to you in certain situations. To enroll in an Aflac plan, click on the Aflac link in our Annual Enrollment site (progressive.com/benefits2017). Do I need to elect life insurance for myself in order to elect life insurance for my spouse and/or child(ren)? Yes. Progressive provides $25,000 in basic life insurance to you free. You can purchase additional levels of optional life insurance in multiples of your salary. To enroll in spouse life, you must elect optional life insurance for yourself that s at least the same amount as the spouse life you re electing. The same guideline applies for child life insurance. Are there any plans in place to further evaluate and/or change the current health benefit plans offered? We continually evaluate our plans and benefit offerings. We gather competitive intelligence about benefit offerings to help guide us in our strategic planning. We evaluate our plan design and performance each year and consider alternatives that may make sense for Progressive and for us. It s an ongoing effort to balance all needs and deliver the most value to the most people. Our goal continues to be for us as Progressive people to be actively engaged consumers focused on prevention, active wellness program participation, and use of available tools to improve our health and effectively manage health care costs. Each of us has a responsibility to be educated consumers and to do our part to reduce health risks, lead a healthy lifestyle, get preventive care, and spend our health care dollars with care and planning. We design our plans to align health care costs with controllable usage/risk to more accurately reflect each individual s health care needs. As we move forward, we ll continue to be a committed partner in supporting healthy lifestyles by offering programs, tools, and resources that support healthy behaviors and wellness for Progressive employees and their families.

5 MEDICAL What are deductibles, coinsurance, and out-of-pocket maximums? Each year you pay the first portion of your covered medical expenses, known as the annual deductible. Once you pay your deductible, Progressive pays 80% of your in-network covered medical expenses and you pay the remaining 20%. The remaining percentage represents your out-of-pocket cost, or coinsurance. For your protection, both of our plans include a limit on the amount you could pay each year for covered expenses. This is called the out-of-pocket maximum. It includes your deductible and coinsurance, but doesn t include any out-of-network charges above what is reasonable and customary in your area (the going rate ). Once you reach the out-of-pocket maximum, Progressive pays 100% of your covered medical expenses for the rest of the year. The Standard Deductible plan has a separate out-of-pocket maximum for prescription expenses, which is $2,500 for an individual and $5,000 for a family. I read that in-network preventive care is covered 100%, but what qualifies as preventive? We follow the U.S. Preventive Services Task Force (USPSTF) national preventive care guidelines and the guidelines outlined by the health care reform law. The guidelines include recommended doctor visits like annual physicals, routine eye and hearing exams, well child care, and preventive screenings. You can find additional details in the Coverage Overview. What s the difference in prescription coverage between our two plans? The types of prescriptions covered are the same in both plans, but there are differences in the amount you ll pay and how those costs are tracked. In the High Deductible plan, prescription coverage is integrated with your medical plan, meaning that it counts toward your deductible and out-of-pocket maximum. Basically, prescription expenses on the High Deductible plan will be handled just like expenses for a visit to the doctor. You ll be able to take advantage of a discounted price (Aetna discounts for medical and Caremark discounts for prescriptions). Until your deductible is met, you ll pay 100% of the discounted amount of the prescription. Once the deductible is met, you ll pay 20% of the cost of the prescription, and Progressive will pick up the remaining 80%. Once your out-of-pocket limit is reached, Progressive will pick up 100% of your prescription costs. In the Standard Deductible plan, prescription costs do not count toward your deductible, as prescription expenses are not integrated with your medical plan. You ll pay a percentage of your prescription costs in this plan, up to an out-of-pocket maximum of $2,500 per person or $5,000 per family. This is the most you ll pay for your prescriptions in a given year. The prescription out-of-pocket maximum is separate from the medical plan out-of-pocket maximum. How does coordination of benefits work with a spouse s insurance? If you re on a Progressive plan, we pay primary, or first, for you. If your spouse has insurance under his or her plan, that plan pays primary for your spouse. If your spouse s plan benefit is equal to or more than Progressive s benefit plan, then Progressive will not pay a benefit for your spouse. For example, if your spouse s plan is an 80/20% coinsurance plan like Progressive s, then Progressive will not pay any additional benefits for your spouse. If your spouse s plan pays less than Progressive s plan, Progressive may pay the difference between the two plans. For example, if your spouse s plan is a 50/50% coinsurance plan, Progressive may then pay the difference for covered services (30%). If you cover dependents, the spouse with the earliest birthday in the year covers the children as primary on their plan.

6 One of my doctors asked me for payment while I was at the office. Should I be paying the doctor before I receive my Explanation of Benefits from Aetna? There are some areas of the country where providers are requesting payment while you re at the office. Providers can contact insurance companies to determine your remaining deductible amount and they can request payment for their services up to that amount. Neither Progressive nor Aetna can control how providers charge for their services, but ideally your provider should be following the standard claims-submission process. This involves first submitting the claim to Aetna so they can apply the negotiated rate to the claim and notify your provider of the amount you owe. You then receive the provider s statement in the mail and make your required payment. If you do find yourself in this situation, we d recommend that you work with your provider and ask if the normal claims process can be followed. Ultimately, however, each provider can choose how they want to bill patients. DENTAL What are my dental plan options? There are two dental options to choose from: the Progressive Dental Plan and the Aetna DMO Dental Plan. Both options cover nearly the same dental services the primary difference will be the DMO Plan offers some greater benefits in exchange for using a narrower list of Aetna DMO network providers. However, if you enroll in the Aetna DMO Plan and use a provider outside of the Aetna DMO network, you will not have coverage for your services. If your dentist is not in the Aetna DMO network, then the Progressive Dental Plan would be the choice for you. If your dentist is in the Aetna DMO network (or you re willing to switch to a participating dentist), then enrolling in the Aetna DMO Dental Plan may offer you lower coinsurance and some greater financial benefits. Below is a high level comparison of the two dental plans. Please see the Dental Plans Comparison flyer and the Coverage Overview for a complete comparison of covered services, as there are some coverage differences between the plans. Lastly, dentists in the Aetna DMO Plan keep a list of eligible patients that s updated monthly. To avoid any delay in receiving dental services under this plan, log in to aetna.com in early December and choose your Primary Care Dentist. Your name will appear on your dentist s list when it is updated the month after your selection. This process is only required for the Aetna DMO Dental Plan, not the Progressive Dental Plan. The fully insured Aetna DMO plan is not available in all areas. Why isn t my dentist in the network? Because dental networks are not nearly as broad or comprehensive as medical networks, the Progressive Dental Plan allows you to choose any dentist and the percentage of covered services Progressive will pay for both in-network and out-of-network dental care remains the same. The difference is that your cost for out-of-network dental care will be based on how much your dentist charges. For example, Progressive covers preventive dental services in-network at 100%. Out-of-network preventive care is also covered at 100%, but it s 100% of the going rate in your area. If your dentist charges more than this amount, you re responsible for the difference. If you re considering the Dental DMO Plan, be sure to confirm your dentist(s) is in the Aetna DMO network prior to enrolling, as using an out-of-network dentist will not be covered.

7 Do I need to get pre-certification for dental work? For treatments over $100, you should get a pre-treatment estimate. This helps determine if your service is covered under the plan and what the plan will pay for the treatment. You can ask your dentist or orthodontist to submit a treatment plan to Aetna. The treatment plan should include the recommended service and its costs, as well as supporting X-rays and other records. Aetna will review the information, determine if the service is covered and what the plan will pay, and notify you and your dentist or orthodontist. This way you ll know ahead of time what your portion of the bill will cost. Pre-treatment estimates also help determine how services are covered, as there are certain dental services that may fall under your medical plan, such as extraction of impacted wisdom teeth. Flexible Spending Account (FSA)/Health Savings Account (HSA) How much will I really save using an FSA? The average savings on eligible services by using a health care and/or child/adult care FSA is 35%. This percentage may vary depending on your individual tax bracket and residency. What s the difference between the Health Care FSA and the Child/Adult Care FSA? The Health Care FSA is used to set aside pre-tax money toward the cost of health care expenses for you and your eligible dependents. Eligible expenses include deductibles, coinsurance, and prescription drugs. The Child/Adult Care FSA is used to set aside pre-tax money toward the cost of caring for your eligible dependents. Eligible expenses include day care centers (for children or adults) and nursery schools. Can I have an FSA and an HSA? No. IRS guidelines don t allow people to have a Health Care FSA and an HSA. Also, HSAs are only offered with the High Deductible plan. Keep in mind that you re able to have a Child/Adult Care FSA and an HSA because the Child/Adult Care FSA is used toward the cost of caring for your eligible dependents and not for their health care costs. When is the money I put into an FSA or HSA available for reimbursement? When you submit a claim for your health care FSA, you ll be reimbursed up to the full amount of your annual election, regardless of the amount of money that has been deposited into your account. Contributions will continue throughout the year and claims will continue to be paid until your annual maximum is met. Child/Adult Care FSA claims are paid a little differently. If you submit a claim and your balance is less than the amount of your claim, you ll only be reimbursed for the amount of money available in your account. The remainder will be reimbursed once money is deposited into your Child/Adult Care FSA. This enables you to submit a claim only once and receive reimbursement on an ongoing basis, rather than be denied payment or be forced to resubmit the claim until it can be paid in full. Lastly, HSAs work similarly to checking accounts in that reimbursement from your account is limited to the amount of money currently in your account. If I contribute money to an FSA and don t use it by the end of the year, do I lose it? You can incur eligible expenses from January 1, 2017 through December 31, You have until March 31, 2018 to submit those 2017 expenses. If you have funds remaining at the end of 2017, you will be able to carry over up to $500 of your remaining balance into 2018, for use on 2018 expenses. The IRS will require that you forfeit any remaining balance over $500. What if I don t use all of my HSA funds by the end of the year? If you have a balance in your HSA at the end of the year, you do not lose those unused dollars. Any money you don t use rolls over into next year and continues to accrue interest. Of course, if you ve directed a portion of your HSA balance into investment options, those options could gain or lose money based on what you ve elected and market activity.

8 I m planning to use my FSA for orthodontia expenses. Is there anything I need to know? If you are using your FSA for orthodontia expenses, it's important to understand the reimbursement guidelines. FSA reimbursement for orthodontia is based on when the services are provided not when your payment is made. If you re paying upfront for orthodontia expenses to receive a discount from your provider, keep in mind that FSA reimbursement will be distributed over the course of treatment, which typically runs for more than a year. Please contact the HR Service Center if you have questions. I currently have a health care FSA and am considering enrolling in the High Deductible Plan and opening an HSA. Is there anything I should know? If you have a health care FSA this year and elect to open an HSA next year, you must have a zero balance in your FSA as of December 31,, in order to contribute to an HSA in If you have a balance, the IRS mandates you cannot contribute to an HSA in 2017, regardless of when you exhaust that balance during the year. Since the IRS requires the actual balance to be zero by year-end, be sure to allow adequate time for Aetna to process any late year reimbursements. If your FSA isn t exhausted by December 31, your HSA election will be cancelled. Are FSA debit cards available? We currently have two ways to reimburse your eligible FSA expenses. They can be automatically or manually submitted. We had the option of offering either automatic submission or debit cards, but were unable to offer both. Because we are able to coordinate all of our vendors with Aetna, automatic submission is the most beneficial for employees. With automatic submission, all medical, dental, vision, and prescription charges that you re responsible for are automatically submitted to Aetna so there s no action required on your part. In most cases, automatic submission results in reimbursement from your FSA before you even receive your provider s bill! Can I increase my FSA or HSA contribution amount at any time? You re not able to change your FSA contribution amount mid-year unless you have a qualifying life event (e.g., marriage, birth, adoption). One of the benefits of an HSA is that you re able to make contributions throughout the year. Like the FSA, contributions to an HSA can be made pre-tax through payroll deduction. In addition, mid-year HSA contributions can be made post-tax through an online bank transfer or check (with an HSA deposit slip).